Speech and Swallowing Difficulties

Written by: Katie Murphy │Last reviewed: April 2022 | Last updated: June 2022

Parkinson's disease (PD) is a long-term, progressive disease that affects the nervous system. Some of the most common symptoms of Parkinson's disease include:1

  • Tremors or shaking at rest
  • Stiffness in the limbs and trunk (rigidity)
  • Slowness of movement or gradual loss of spontaneous movement (bradykinesia)
  • Problems with balance (postural instability)

However, PD can also cause many speech and swallowing problems, which can severely affect social interaction.1,2

What speech problems can PD cause?

Like other symptoms in PD, problems with speech vary from person to person. However, some people may have speech that is:3

  • Slurred
  • Mumbled
  • Shaky
  • Monotone
  • Too rapid to understand
  • Slow
  • Stammering
  • Soft, breathy, or hoarse

Many people with PD find that they have difficulty finding the right words, which is often frustrating.3

Swallowing problems

With the progression of PD, a person might also have even more problems with speech and language. In addition, swallowing becomes even more challenging.2,3

Swallowing problems (dysphagia) can cause food or saliva to go down into the lungs instead of the stomach. This is called aspiration, and it increases the risk for lung infections.2,3

Aspiration pneumonia is life-threatening and is the leading cause of death in those with PD. Recognizing swallowing problems and being able to eat safely is a priority to live a healthy life with PD.2

How do they appear in PD?

The muscle problems that occur in PD can lead to problems with swallowing. Swallowing problems can be hard to figure out at first but may include:2

  • Unexplained weight loss
  • Drooling
  • Choking or coughing while eating or drinking
  • "Pocketing" of food in the mouth
  • Frequent heartburn or sore throat
  • Trouble keeping food or liquid in your mouth while eating or drinking

What is the cause?

PD damages the nerves in the brain. It causes problems with movement and communication, including changes in speech. The exact way that PD causes speech and swallowing problems remains unclear.4,5

The nerve cells (neurons) in the heavily damaged area of the brain produce dopamine. This is a chemical messenger (neurotransmitter) that transmits signals to parts of the brain that help regulate smooth, purposeful movement.4

The muscles in the face, mouth, and throat also need to move to generate speech and help with swallowing. Doctors think that damage to dopamine-producing nerve cells leads to dysfunction in the movement of muscles involved in speech and swallowing, along with those in the trunk and limbs.4

Treatment

There is currently no cure for Parkinson's disease, and no treatment is known to halt or slow its progression. Drugs, surgery, and alternative medicine are all available therapies that can help people live with their symptoms.4

Speech therapy

People with PD who have speech and swallowing problems can benefit from speech therapy. A speech therapist or speech-language pathologist can help with many issues related to communication. They can assess your symptoms and help you improve speaking, language, and swallowing.2,3,5

The Lee Silverman Voice Treatment (LSVT) is a treatment program for PD that consists of several exercises designed for people with the condition. People with PD have shown lasting improvements, especially when it comes to regulating their vocal pitch.2,5

Collagen injections

An ear, nose, and throat (ENT) doctor performs this procedure. The doctor injects collagen directly into the vocal cords to help them completely close while speaking. Some people have found this therapy helps with speech problems related to PD. Like all treatments, talk to your doctor to see if this might be a good option for you.2

Other tips include:3

  • Communication devices like portable amplifiers
  • Positioning to face a person while speaking to reduce confusion
  • Turning off background noise like fans and TVs while speaking and listening
  • Reducing physical barriers that can make speech more difficult
  • Speak slowly
  • Use short phrases

Saliva control

Many people with PD have too much saliva in their mouth, which leads to drooling and swallowing problems. Your doctor might suggest sucking on certain candies or prescription drops that go under your tongue to dry up the saliva. Like all treatments, these have side effects. Talk to your doctor about whether or not these options are right for you.2

Progression of Parkinson's

Finally, speech and swallowing problems can be frustrating and can sneak up on you over time. While these problems can happen at any point in your PD journey, you are more likely to have them as your PD progresses.

Plus, speech problems often go hand in hand with swallowing issues, which can be life-threatening. Be sure to talk to your doctor about getting an assessment from a speech therapist, and ways to manage your communication and swallowing. Also, do not forget to talk about the social challenges you may be having due to speech issues.1-5

PD can cause communication challenges, but with the right resources and planning, you can ease many frustrations the disease might bring.

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